Provider Demographics
NPI:1447208673
Name:HURLEY, JOHN BEN (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BEN
Last Name:HURLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-2443
Mailing Address - Country:US
Mailing Address - Phone:319-233-3852
Mailing Address - Fax:
Practice Address - Street 1:1536 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-2443
Practice Address - Country:US
Practice Address - Phone:319-233-3852
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA015602251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic